Prevention in Practice

Eat Your Vegetables… Or Else

AJPM recently published an article on agricultural subsidies, a topic you probably consider an excellent sleep aid. But wait, here’s the opening sentence, “Current agricultural policies in the U.S. are contributing to the poor health of Americans.”

Not many people disagree that diet is one of the major modifiable determinants in promoting or preventing chronic disease. The argument made in the AJPM article is that agricultural subsidies have shaped the American nutrition environment by promoting the overproduction of the basic ingredients of processed, energy-dense foods. The usual suspects are fats and oils, sugars, and refined grains, meaning fatty meat, corn sweeteners, and fried food.

Fats and sugars are major components of our energy-dense diet, and can be tracked upstream to farms and subsidies for commodities. Corn, livestock, and dairy programs receive enormous annual subsidies. Subsidies also support the use of grain and oilseed as feed for livestock, helping Americans to consume an average of over 200 pounds of meat and poultry annually.

The authors of the study assert that public health officials have had little say in shaping the American food system, and the current nutrition environment “remains uninformed by healthy eating practices.”

Photo courtesy of Vampire Bear.

Strong assertions indeed, but European public health professionals have leveled similar criticisms at farm subsidies. There, the public health nutrition narrative has only recently gained traction in agricultural policy circles, as health groups become increasingly vocal in their call for policies to contribute toward preventing or resolving food-consumption problems. More attention should be paid, it is argued, on intervention policies upstream, at the primary food production and processing stages, to influence nutritional quality.

Meat consumption is a case in point. Globally, per-capita consumption is increasing, thanks largely to rising incomes in the developing world. But the U.S. is experiencing a record decline in meat consumption (which some might see as a silver lining on a dire economic cloud). U.S. per-capita consumption of meat and poultry fell by 10%, from 221 pounds in 2007, to 200 pounds in 2012, (U.S. Department of Agriculture). Reasons for the decline are partly economic, as households are becoming poorer at the same time that prices for food staples are rising. The recession has simply made meat less affordable for American consumers.

Federal subsidies certainly play a supporting role in our “current nutritional environment,” but lag behind that of food-based dietary guidelines (think pyramids). And in that regard, there is eroding consensus that meat and dairy are essential elements of a well-balanced diet. Diet and mortality is an important area of study, and vegetarian diets have been associated with reductions in risk for several chronic diseases, including hypertension, metabolic syndrome, diabetes mellitus, and ischemic heart disease. Recent research includes a study published in JAMA Internal Medicine, finding that vegetarian diets are associated with lower all-cause mortality and with some reductions in cause-specific mortality. The authors recommend that these favorable associations be considered carefully by those offering dietary guidance.

A nicely produced recent documentary, Forks Over Knives, promotes this theme. It focuses on the work of two prominent doctors whose studies convinced them that a whole-food plant-based diet should be a primary approach to treatment of noncommunicable disease. They treat food as medicine and the basis for good health, and concur with the main arguments in the AJPM article.

The tragic life of Dr. Ignaz Semmelweis offers an example of the challenges faced in building a truly learning health care system. The Hungarian physician observed that simply washing hands could drastically reduce high rates of maternal death during childbirth. But since he could not prove a connection between hand washing and the spread of infection, he was ridiculed and ignored. Hounded out of his profession, he died in a mental hospital.

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